Identification of Seniors at Risk (ISAR) in the emergency room

Older adults (OA) often experience adverse events after an emergency department (ED) visit. Identified OA at risk for adverse outcomes at initial index visit of emergency department care is recommended | International Emergency Nursing

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Image source: Andrea Squatrito – Flickr // CC BY-NC-ND 2.0

Introduction: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED.

Methods: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated.

Results: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff ≥ 2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180 days.

Discussion: The ISAR predicted returns to EDs at 30 and 180 days for OAs at risk, but was unable to predict early or late hospital readmission.

Full reference: de Almeida Tavares, J.P. et al. (2017) Identification of Seniors at Risk (ISAR) in the emergency room: a prospective study. International Emergency Nursing. Published online: 2 June 2017

Acceptability of Universally Offered Gonorrhea and Chlamydia Screening

This study is an exploration of adolescent and parent or guardian attitudes about benefits and barriers to universally offered gonorrhea and chlamydia screening and modalities for assessing interest in screening in the pediatric emergency department | Annals of Emergency Medicine

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Methods: A convenience sample of forty 14- to 21-year-olds and parents or guardians of adolescents presenting to an urban and community pediatric ED with any chief complaint participated in individual, semistructured, confidential interviews. Topics included support of universally offered gonorrhea and chlamydia screening, barriers and benefits to screening, and modalities for assessing interest in screening. Data were analyzed with framework analysis.

Results: Almost all adolescents (37/40; 93%) and parents (39/40; 98%) support offering ED gonorrhea or chlamydia screening. Benefits included earlier diagnosis and treatment, convenience and transmission prevention (cited by both groups), and improved education and long-term health (cited by parents/guardians). Barriers included concerns about confidentiality and cost (cited by both groups), embarrassment (cited by adolescents), and nondisclosure to parents or guardians (cited by parents/guardians). Adolescents preferred that the request for gonorrhea or chlamydia screening be presented in a private room, using tablet technology. Both groups noted that the advantages to tablets included confidentiality and adolescents’ familiarity with technology. Adolescents noted that tablet use would address concerns about bringing up gonorrhea or chlamydia screening with clinicians, whereas parents or guardians noted that tablets might increase screening incidence but expressed concern about the lack of personal interaction.

Conclusion: Universally offered gonorrhea and chlamydia screening in a pediatric ED was acceptable to the adolescents and parents or guardians in this study. Offering a tablet-based method to assess interest in screening may increase participation.

Full reference: Reed, J.L. et al. (2017) A Qualitative Analysis of Adolescent and Caregiver Acceptability of Universally Offered Gonorrhea and Chlamydia Screening in the Pediatric Emergency Department. Annals of Emergency Medicine. DOI:10.1016/j.annemergmed.2017.04.017.

Refusal of Emergency Medical Treatment

Informed consent should also be obtained for emergency medical interventions that may entail significant risk | Annals of Emergency Medicine

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Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans.

Full reference: Marco, C.A. et al. (2017) Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations. Annals of Emergency Medicine. DOI: 10.1016/j.annemergmed.2017.04.015

Sepsis care in UK Emergency Departments is improving

Sepsis care is improving but treatment needs to be faster, according to a new audit by the Royal College of Emergency Medicine.

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Image source: http://www.rcem.ac.uk

The report published this month audited 13,129 adults presenting to 196 Emergency Departments (EDs), and was endorsed by the Sepsis Trust.  It shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster.

The audit is designed to drive clinical practice forward by helping clinicians examine the work they do day-to-day and benchmark against their peers, and to recognise excellence.  There is much good practice occurring and RCEM believes that this audit is an important component in sharing this and ensuring patient safety.

The report finds that there has been a steady improvement in the ‘Sepsis-Six’, an initial resuscitation bundle designed to offer basic interventions within the first hour of arriving at an ED. However, despite seeing improvements in care, the report finds that RCEM standards are not yet being met by all EDs.

Full report:  Severe Sepsis and Septic Shock. Clinical Audit 2016/17

Emergency department frequent users

Birmingham, L.E. et al. BMC Emergency Medicine | Published online: 10 May 2017

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Background: There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted.

 

Conclusion: This study characterized ED frequent users and identified several opportunities to better serve this population. By understanding barriers to care from the patient perspective, health systems can potentially address unmet needs that prevent wellness in this population.

Read the full article here

Patient flow within UK emergency departments

Mohiuddin, S. et al. (2017) BMJ Open. 7:e015007

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Objectives: Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK.

 

Conclusions: We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies.

Read the full article here

Ultrasound for children with broken arms: Accurate, faster, less painful than X-rays

Point-of-Care Ultrasound (POCUS) assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction | ScienceDaily

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There are many goals when managing children with suspected fractures of the arm. These include being fast and accurate in the diagnosis, not causing more pain and limiting exposure to radiation. Achieving these goals can result in high rates of caregiver satisfaction. Dr. Poonai’s study suggests that POCUS may be a viable alternative to x-ray with respect to diagnostic accuracy, cost effectiveness, pain, caregiver satisfaction, and procedure duration.

Read the full overview via ScienceDaily here

The original research article is available here